Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19. J Intensive Care Med 2022 Apr;37(4):500-509
Date
12/24/2021Pubmed ID
34939474Pubmed Central ID
PMC8926920DOI
10.1177/08850666211067509Scopus ID
2-s2.0-85122130775 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
OBJECTIVE: To determine whether surge conditions were associated with increased mortality.
DESIGN: Multicenter cohort study.
SETTING: U.S. ICUs participating in STOP-COVID.
PATIENTS: Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 - May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals).Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI]: 1.30 [0.47-3.58], pā=ā.6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43], pā<ā.001).
CONCLUSIONS: Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.
Author List
Keene AB, Admon AJ, Brenner SK, Gupta S, Lazarous D, Leaf DE, Gershengorn HB, STOP-COVID InvestigatorsAuthor
Christina Mariyam Joy MD Assistant Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultCohort Studies
Critical Illness
Female
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged